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Lateral Condyle Fracture (Peds)
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Contents
Other Names
- Lateral Epicondyle Fracture
- Lateral Humeral Condyle Fracture
Background
- Refer to fracture of the lateral condyle of the Humerus in pediatric patients
- Prognosis is worse than other pediatric elbow fractures due to high risk of malunion, nonunion and often missed diagnosis
Epidemiology
- Second most common elbow fracture in children[1]
- 12-20% of pediatric elbow fractures
- Average age is 6[2]
Pathophysiology
- Etiology most often involves FOOSH injury
- Pull off theory: avulsion of lateral condyle from common extensor muscles/ tendon[3]
- Push off theory: Fall causes impaction of radial head into lateral condyle, pushing off lateral condyle[4]
- Most likely a combination of both mechanisms[5]
- Most commonly presents as aSalter Harris IV fracture pattern
Ossification Centers of the Elbow
Ossification center | Age of Appearance on Xray | Age of fusion |
Capitellum | 1 | 12 |
Radial Head | 3 | 15 |
Medial Epicondyle | 5 | 17 |
Trochlea | 7 | 12 |
Olecranon | 9 | 15 |
Lateral Epicondyle | 11 | 12 |
Associated Injuries
Risk Factors
- Unknown
Differential Diagnosis
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Clinical Features
- General: Physical Exam Elbow
- History
- Describe trauma, typically fall on outstretched hand
- Reports lateral elbow pain, swelling, bruising
- Physical
- Unlikely deformity unless concomitant dislocation
- Tenderness, bruising, swelling of lateral condyle
- Ecchymosis implies unstable fracture (tear of aponeurosis of brachioradialis)
- Pain with elbow flexion/extension, especially supination, wrist flexion
Evaluation
- Radiographs
- 3 view radiographs standard
- Compare to contralateral elbow if unclear
- Internal Oblique: Fracture fragment best seen[6]
- AP: May demonstrate small metaphyseal flake
- Arthrogram
- Useful for minimally displaced fractures
- CT
- Indicated only in uncertain cases
- MRI
- Assess integrity of cartilage
- Hard to perform in young children, require sedation
- Ultrasound
- Useful to evaluate articular cartilage
- Can be used reliably to distinguish intact articular cartilage from an interrupted cartilaginous joint surface[7]
- Requires skilled sonographer
Classification
Milch Classification
- Type 1: Fracture line is lateral to trochlear groove (less common, stable)
- Type II: Fracture line extends medially into trochlear groove (more common, unstable)
Fracture Displacement Classification - Weiss
- Type 1: <2 mm, indicating intact cartilaginous hinge
- Account for up to 69% of fractures[8]
- Type 2: >2 mm and <4 mm displacement, intact articular cartilage on arthrogram
- Type 3: >4 mm, articular surface disrupted on arthrogram
Management
Nonoperative
- Controversial, recommend making decision in consultation with orthopedic surgeon
- Indications
- Type I (nondisplaced or <2 mm displacement)
- Medial cartilage must be intact (confirmed on MRI)
- Immobilization: Long Arm Cast at 90°
- Duration is controversial, 3-7 weeks [9]
- Repeat radiographs weekly (cast must be removed)
Operative
- Indications
- 2+ mm displacement
- Technique
- Closed reduction, percutaneous pinning (CRPP)
- ORIF
- Supracondylar osteotomy
Return to Play
- Variable, discretion of surgeon
Complications
- Nonunion
- Malunion
- Avascular Necrosis
- Stiffness/ loss of ROM
- Delayed union
- Varus/Valgus
- Growth Arrest
- Lateral overgrowth
See Also
- Internal
- External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Landin LA: Fracture patterns in children: Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta Orthop Scand Suppl 1983;202:1-109
- ↑ Stimson L: A Practical Treatise on Fractures and Dislocations. Philadelphia, PA, Lea Brothers & Co, 1900
- ↑ Jakob R, Fowles JV, Rang M, Kassab MT: Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br 1975; 57(4):430-436
- ↑ Milch H: Fractures and fracture dislocations of the humeral condyles. J Trauma 1964;4:592-607
- ↑ McLearie M, Merson RD: Injuries to the lateral condyle epiphysis of the humerus in children. J Bone Joint Surg Br 1954; 36(1):84-89.
- ↑ Song KS, Kang CH, Min BW, Bae KC, Cho CH: Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg Am 2007;89(1):58-63
- ↑ Vocke-Hell AK, Schmid A: Sonographic differentiation of stable and unstable lateral condyle fractures of the humerus in children. J Pediatr Orthop B 2001; 10(2):138-141
- ↑ Rutherford A: Fractures of the lateral humeral condyle in children. J Bone Joint Surg Am 1985;67(6):851-856
- ↑ Badelon O, Bensahel H, Mazda K, Vie P: Lateral humeral condylar fractures in children: A report of 47 cases. J Pediatr Orthop 1988;8(1):31-34.
Created by:
John Kiel on 18 June 2019 01:16:38
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Last edited:
13 October 2022 13:25:51
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